Maternal mortality reflects the risk to mothers during pregnancy and child birth and is an useful indicator of maternal health. Unfortunately, an accurate estimate of maternal mortality rate (MMR) is not feasible in the absence of a regular source of relevant data. A developed cause of death reporting system and civil registration of vital events would yield precise estimate of MMR. While efforts are on develop civil registration and cause of death reporting in India , these are likely to take some time to yield the representative sample sizes required for estimation of MMR. The reproductive and child health (RCH) programs, in the mean while, require a feasible and cost-effective system to monitor MMR trends in different parts of the country and relate them to programmatic efforts. This study to develop a prospective surveillance system of estimating MMR has been designed for this purpose. The proposed system will follow up about 25000 pregnancies through a set of randomly chosen sub centres from any given population for which MMR estimate is required. All pregnant women will be recruited into the study through public or private health care providers from whom such women may seek antenatal care. Those not actively seeking antenatal care will be recruited into the study and assigned to the local sub centre for antenatal care. Two field visits will be made. First will gather socioeconomic characteristics, health data and collect all contact addresses for the woman. Each pregnant woman will be followed up to ascertain the pregnancy outcome. Second visit will be made within six month of the expected date of delivery (EDD) to document the nature of delivery and its outcome. A pilot study has been proposed to take place in Mahaboobnagar district of Andhra Pradesh.